外阴阴道萎缩的诊断和治疗根据国际指南

K. V. Dmitrienko, S. D. Yavorskaya, G. V. Nemtseva
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引用次数: 0

摘要

外阴阴道萎缩是雌激素缺乏引起的泌尿生殖系统症状之一,导致阴道上皮发育不成熟,糖原缺乏,乳酸菌减少甚至消除,继发泌尿生殖道感染。主要症状包括干燥、灼烧、瘙痒和性交困难。诊断通常基于患者的主诉、体征和症状。外阴阴道萎缩的管理包括各种形式的外用雌激素和非激素药物。低剂量阴道雌激素可作为单一疗法或作为激素替代疗法(HRT)的补充。在单药治疗的情况下,不需要添加黄体酮来保护子宫内膜。根据最近的研究,局部阴道雌激素治疗不会增加癌症、心血管疾病和静脉血栓栓塞的风险。对于激素恐惧症患者,另一种治疗方法是使用阴道润滑剂和保湿剂或患有各种局部癌症的患者。例如,与安慰剂相比,在乳腺癌幸存者中使用乳酸阴道凝胶可以改善阴道干燥和性交困难。然而,阴道雌激素治疗的临床效果优于非激素类药物。
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Diagnostics and management of vulvovaginal atrophy according to the international guidelines
Vulvovaginal atrophy is one of the genitourinary symptoms caused by estrogen deficiency which leads to the development of immature vaginal epithelium, glycogen deficiency, reduction or even elimination of lactobacilli, and secondary genitourinary tract infection. Among the main symptoms were dryness, burning, itching, and dyspareunia. Diagnosis is typically based on the patient’s complaints, signs, and symptoms. Management of vulvovaginal atrophy includes various forms of topical estrogens and non-hormonal drugs. Low-dose vaginal estrogens can be used as monotherapy or as a supplement to hormone replacement therapy (HRT). In the case of monotherapy, there is no need to add progesterone for the endometrial protection. According to the recent studies, local vaginal estrogen therapy does not increase the risk of cancer, cardiovascular disease, and venous thromboembolism. On patients with hormonophobia, an alternative method of treatment is the use of vaginal lubricants and moisturizers or who have had cancers of various localization. For instance, usage of lactic acid vaginal gels in breast cancer survivors has improved vaginal dryness and dyspareunia as compared with the placebo. Yet, vaginal estrogen therapy has better clinical effects than non-hormonal drugs.
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